| Entity Name: | FI-CARROLLWOOD CARE, LLC |
| Jurisdiction: | FLORIDA |
| Filing Type: | Florida Limited Liability Co. |
| Status: | Active |
| Date Filed: | 23 Dec 2002 (22 years ago) |
| Last Event: | LC STMNT OF RA/RO CHG |
| Event Date Filed: | 22 Feb 2016 (9 years ago) |
| Document Number: | L02000034765 |
| FEI/EIN Number | 32-0051414 |
| Address: | 1665 Palm Beach Lakes Blvd., Suite 400, West Palm Beach, FL, 33401, US |
| Mail Address: | 1665 Palm Beach Lakes Blvd., Suite 400, West Palm Beach, FL, 33401, US |
| ZIP code: | 33401 |
| County: | Palm Beach |
| Place of Formation: | FLORIDA |
| NPI | Enumeration Date | Last Update Date | Mailing Address | Practice Location Address | |||||||||||||||||||||||||||
|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|
| 1447254107 | 2005-06-10 | 2012-10-09 | 1675 PALM BEACH LAKES BLVD, SUITE 900, WEST PALM BEACH, FL, 33401, US | 15002 HUTCHISON RD, TAMPA, FL, 336255509, US | |||||||||||||||||||||||||||
|
|||||||||||||||||||||||||||||||
| Phone | +1 561-801-7600 |
| Phone | +1 813-960-1969 |
| Fax | 8139608510 |
Authorized person
| Name | HOWARD JAFFE |
| Role | PRESIDENT |
| Phone | 2153466454 |
Taxonomy
| Taxonomy Code | 314000000X - Skilled Nursing Facility |
| License Number | SNF1077095 |
| State | FL |
| Is Primary | Yes |
Other Provider Identifiers
| Issuer | MEDICAID |
| Number | 026387700 |
| State | FL |
| Name | Role |
|---|---|
| C T CORPORATION SYSTEM | Agent |
| Name | Role | Address |
|---|---|---|
| Jaffe Howard | Manager | 1665 Palm Beach Lakes Blvd., West Palm Beach, FL, 33401 |
| Registration Number | Fictitious Name | Status | Filed Date | Expiration Date | Cancellation Date | Mailing Address |
|---|---|---|---|---|---|---|
| G20000122972 | CARROLLWOOD CARE CENTER | ACTIVE | 2020-09-22 | 2025-12-31 | No data | 15002 HUTCHINSON ROAD, TAMPA, FL, 33625 |
| Event Type | Filed Date | Value | Description |
|---|---|---|---|
| CHANGE OF PRINCIPAL ADDRESS | 2024-03-11 | 1665 Palm Beach Lakes Blvd., Suite 400, West Palm Beach, FL 33401 | No data |
| CHANGE OF MAILING ADDRESS | 2024-03-11 | 1665 Palm Beach Lakes Blvd., Suite 400, West Palm Beach, FL 33401 | No data |
| LC STMNT OF RA/RO CHG | 2016-02-22 | No data | No data |
| REGISTERED AGENT NAME CHANGED | 2016-02-22 | C T CORPORATION SYSTEM | No data |
| REGISTERED AGENT ADDRESS CHANGED | 2016-02-22 | 1200 SOUTH PINE ISLAND ROAD, PLANTATION, FL 33324 | No data |
| Name | Date |
|---|---|
| ANNUAL REPORT | 2024-03-11 |
| ANNUAL REPORT | 2023-02-27 |
| ANNUAL REPORT | 2022-04-01 |
| ANNUAL REPORT | 2021-04-08 |
| ANNUAL REPORT | 2020-04-22 |
| ANNUAL REPORT | 2019-03-29 |
| ANNUAL REPORT | 2018-04-09 |
| ANNUAL REPORT | 2017-04-12 |
| ANNUAL REPORT | 2016-04-30 |
| CORLCRACHG | 2016-02-22 |
Date of last update: 02 Feb 2025
Sources: Florida Department of State
